Wednesday, May 7, 2014

The Medication Deliberation

Have you ever had a client say to you, "I'm just not comfortable with medication?" Do you, yourself, ever struggle with whether or not to refer out to a psychiatrist, or if you decide to refer, when it's appropriate?

People - and counselors - have a lot of competing ideas about medication for mental illness.

Is it a panacea? (A sweeping solution, with the implication that some aspects of the patient's needs will slip through the cracks.)

Is it a band-aid, that will slow the damage to a wounded heart but not heal?

Is it a last resort, which should only be used when everything else has been exhausted?

Is it part of the intake process, something that should be dealt with at the beginning of therapy? 

To be honest, there is no one answer that will satisfy all therapists, and all clients. Some therapists, usually categorized as holistic therapists, do not believe in the use of medication, instead integrating alternative therapies like aromatherapy into their practice.

And whatever the therapist believes, the client may be resistant to medication, perhaps saying something like this:

  • It's a sign of weakness.
  • I don't want to "numb out."
  • I want to trust God, not drugs (or) my church doesn't believe in medication.
  • I don't want chemicals in my body.
  • I believe my body can correct itself.
  • I want to try the natural approach. 

Whatever you believe (or your client believes) there are two major options for how to approach this.

Continue to focus on non-medication alternatives. There are several resources that medical doctors recommend for situations like depression, such as increasing exercise. You might also recommend books like Trudy Scott's The Antianxiety Food Solution

If you choose to recommend medication, I find that you get the best results with your clients when you follow the following guidelines:
  • Do your best to coordinate care with the client's prescribing professional. Ask the client for a release form from the doctor's office to speak with the doctor or the staff nurse about their medication and possible side effects. Most doctors do not have the time to fully explain every possible side effect, and will not see them on a weekly basis. Therefore, your doing research on the medication they are taking for possible side effects can help them greatly. If you see a side effect popping up, you may be able to recognize and intervene more quickly than they can recognize it themselves. 
  • Reinforce medication instructions. Medication non-compliance is one of the BIGGEST challenges facing medical professionals today. A lot of that comes from misunderstandings of the risks of incorrectly taking prescription medications and lack of accountability. For example, many people tend to stop taking anti-depressant or bipolar medication when they start feeling better. But abruptly stopping some medications can drastically increase risk of suicidality and it must be addressed both before and during the implementation of a new medication.
  • Emphasize the client's ability to choose what they do what they feel is right with their medication, but to do it SAFELY. Remind them regularly that you will listen if they truly want to cease medications, even if you do not agree, so that they will share with you if they stop medications and you can help them do it safely. Otherwise, they may hide it from you in order to avoid your 'disapproval' and follow an unsafe medication regimen on their own.
  • Remind them of the importance of discussing non-prescription supplements with their doctors. "Natural" remedies, including St. John's Wort, can STILL interact with certain medications and cause unsafe side effects. 
  • Don't neglect the emotional impact of societal perspectives on medications for mental health. Whether the client's immediate society is their church, their regional area, or their family, it matters what others think about them. They may worry about judgment from others, about keeping 'secrets', about being shunned or blacklisted. They may worry that others will simply think they gave up or sold out. And they may have transferred that judgment to themselves. 
  • Consistently help them see the "big picture."  You can tell them that: "You don't have to be on medication forever, necessarily. Many people believe it is no different than taking a blood pressure medication. You have tried all the other alternatives. You may have to to dull side effects like sleeplessness, apathy, etc., so that you can implement what I am working with you on in talk therapy." Of course, if you don't believe in these things, don't go against your conscience, but if you approve of these statements they may be what the clients need to hear. 
What has been your experience with helping clients who have been prescribed psychiatric medication? What is one tip you think other counselors should know when working with clients considering psychiatric drugs? 

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